[earle58]

i agree w/you, em.
that one needn't be awake at the time of death, in order to qualify it as a conscious one.

as long as the pt, family/friends, have accepted death's limitation here on earth, and can prepare for the next transition, then all is whole...and conscious.

sounds like your 92yo pt's death, was indeed, very meaningful.

leslie

[req_read]

Thanks Leslie & Em…

I agree that it is not necessary to be awake at the moment of death to die consciously… and confess to having muddied the water on that account with some of my posts. Thanks for the clarification.

Conscious death has to do with choice… being aware that death is imminent and choosing to embrace it. Whether one happens to be awake at the precise moment of crossing is irrelevant.

Against a backdrop of the consensus definition of “death,” i.e. “end of life,” choosing to die seems strange, or even macabre.

Against a backdrop of a rational definition of “death” however; e.g. a “transition” to another level of existence (having completed most of the tasks one came to this level to work on) then such a choice seems perfectly sensible and appropriate.

I believe there are cases when a person chooses to leave while in a dream state. From our perspective, these folks would appear to have “died in their sleep.” Even though they were not “awake” at that moment, they still moved on consciously and as a matter of choice.

Then there are cases where it seems that a person might have seen into the future… seen their death before it happened. We have all heard of (or perhaps know of personally) these kinds of cases… and they are interesting to ponder. One might wonder, if a person knew he was going to die, why would he not try to avoid it? One possibility of course is that he might also have seen where he would be following death and was content with going there.

Conscious dying, like conscious living, has many forms or ways of manifesting. Probably most hospice nurses have seen examples, although might not have thought about it in those terms.

Michael

[coralynwoodson]

Managing symptoms for a good death is indeed an atribute of a good nurse. I work for a hospice and this is part of what I do not only as a requirement for being a good nurse, I do this because it is humane. It is degrading to the dying person to be pittied and watched to have distress and not be given the comfort he or she deserve. Most of us have led comfortable lives. Lives without too much pain, suffering. Death can be our friend true enough; but, when someone tells me that " I know my loved one is going to be healed of this disease" and I know that they won't in the way that they think they will be, I then explain to them, death is a healer. To be healed, we see that a person no longer suffers the affects of a disease riddled body; pain, temperaments, confusion and so on. Does not death end this? As we know it, death causes a transistion form life to another form. Life after death now or life after death later, or no life after death at all, it depends on what is accepted by the believer. As for me, I believe, when we are absent in the body, we are either with the Lord or where ever it is designated for us to be. No one came back to tell us. All of this is important for the loved ones of the person who is dying. Lets give people the best celebration of life at the end of life that we can give them. This also manages symptom for a good death. Enjoyed everyone of your threads. They are truly great ones. Coralyn

[nettie01]

WOW!! I remember you guys! I participated in this thread back in 2006! I've been trying to work out where to 'break in' with my practical issue... it's all very interesting, your thoughts. Thanks....
I'm writing to you from New Zealand again. Thank you for any advice from you experts.
I'm a medical nurse currently working in long term care and I've found myself disagreeing with colleagues recently about when it's right to give morphine. I'm very happy to give morphine for pain, respiratory distress and perhaps anxiety but once I was caring for a patient who'd had a large stroke and was unconscious. The decision was made not to hydrate or nourish her - to 'let her go'. The doctor prescribed a morphine/antiemetic/anxiolytic mixture in a syringe driver but the patient looked peaceful and didn't appear to be in pain so I talked to the doctor who was happy for us to use the prescription when we thought fit. Another colleague strongly disagreed and said I should give it to the patient, to keep her comfortable. I prefer to give medication to control symptoms otherwise I feel like I'm doing euthanasia.
It seems to me that some nurses move into a mindset of "This person is Dying now and we will do the thing we do for dying people - give them morphine." I don't like to sedate people unecessarily - they might still be able to talk to relatives. (perhaps not the pt in the example, but others may).
Thank you for your thoughts. I know the issue of conscious death/alertness has been covered. I guess if I just read all the pages of this thread I'd have all the info I needed!
Jeanette
New Zealand

Jeanette